不同组织多普勒技术评价肺源性心脏病患者右室壁功能的研究

Myocardial functions of right ventricular walls in patients with cor pulmonale by different tissue doppler techniques

目的 探讨应用不同组织多普勒技术评价肺源性心脏病（以下简称肺心病）患者右室壁局部心肌收缩功能的价值.方法 获得肺心病患者（肺心病组）和正常人群（对照组）右室前壁、下壁及侧壁的基底段、中段、心尖段心内膜下心肌层的组织速度显像、组织追踪显像、应变显像、应变率显像、组织同步显像曲线后,分别测量每一曲线上的收缩期平均峰值速度、收缩期峰值位移（PDs）、收缩期峰值应变（PSs）、收缩期峰值应变率（PSRs）、达一峰值速度时间（TTPV）;并将各节段的参数与右室射血分数（RVEF）进行相关性分析;同时采用受试工作特征曲线确定与对照组有差别的参数的诊断界值.结果 肺心病组右室壁所有节段的PSs值,前、下、侧壁的基底段及前壁中段的PDs值,前壁基底段、中段及下壁中段PSRs值均小于对照组（P〈0.05或0.01）;在所有相关性分析的参数中,右室前壁基底段PSs值与RVEF高度相关;右室下壁基底段的PSs的界值-22%的诊断价值相对较大,其灵敏度、特异度、准确率分别为72.54%、65.38%、68.92%.结论 组织多普勒技术可评价肺心病患者的右室壁局部心肌收缩功能,尤其是应变显像;利用局部心肌的组织多普勒参数测值可间接反映肺心病患者的右室整体收缩功能.

Objective To evaluate the application of different tissue doppler techniques in examine regional systolic functions of right ventricular walls in patients with cor pulmonale. Methods The curves of tissue velocity imaging, tissue tracking imaging, tissue synchronization imaging, strain imaging and strain rate imaging were obtained in subendocardial layers of basal, mid and apical segments of anterior, inferior and lateral walls of right ventricular, and the average peak systolic velocity （APVs）, peak systolic displacement （PDs）, time-to-peak velocity（TTPV）, peak systolic strain （PSs）, peak systolic strain rate （PSRs） were measured in each curve respectively. The linear correlations were analyzed between every systolic parameters of each segment of right ventricular walls and the right ventricular ejection fraction （RVEF） in patients with cor pulmonale. The diagnostic cut-off values of parameters, which were significantly different from normal subjects were defined by receiver operating characteristic curves （ROC）. Results In cor pulmonale patients, the mean PSs in all segments of right ventricular walls, the mean PDs in basal segments of anterior, inferior, lateral walls and in mid segments of anterior, inferior walls, the mean PSRs in basal, mid segments of anterior walls and in apical segments of lateral walls,the mean TTPV in apical segments of lateral walls were all less than those in normal subjects （P〈O.05 or 0.01）. The correlation between PSs of basal segment of anterior wall and the measurements of RVEF was highest;the cut-off value of PSs of basal segment of inferior wall was - 22%, the diagnostic value would be relatively higher with a sensitivity, specificity and accuracy rate of 72.54%, 65.38% and 68.92% respectively. Conclusion The regional myocardial systolic functions of right ventricular walls in the patients with cot pulmonale can be estimated by tissue doppler techniques, particularly for strain imaging.